Suitability of internet-delivered cognitive behavioural therapy for public safety personnel with subthreshold symptoms

Abstract

Public safety personnel (PSP) are at a high risk of developing mental health challenges due to frequent exposure to potentially psychologically traumatic events (PPTEs). PSP with subthreshold symptoms, those below diagnostic criteria, may benefit from proactively using mental health programs such as the PSP Wellbeing Course, an internet-delivered cognitive behavioral therapy (ICBT) program tailored for PSP. This mixed-methods study explored the suitability of the PSP Wellbeing Course for PSP with subthreshold symptoms by examining treatment engagement, mental health outcomes, resilience, treatment satisfaction, and participant feedback. Quantitative data were collected from 174 pre-existing clients and analyzed using descriptive statistics, paired-samples t-tests, and Hedges’ g to evaluate symptom change from pre-treatment to 8-weeks post-enrollment. Qualitative data from semi-structured interviews with 10 recent clients were analyzed using reflexive thematic analysis to capture participant perspectives. Findings revealed statistically significant reductions in anxiety, depression, and posttraumatic stress symptoms, with maintained subthreshold symptom levels and stable resilience scores. Participants expressed high satisfaction with the course’s structure, flexibility, and relevance, and reported both professional and personal benefits. Qualitative themes highlighted the value of relatable materials, proactive support, therapist involvement, and the importance of early access to mental health tools. Participants also recommended refining ICBT delivery by offering shorter and more diverse case stories, increasing printable resources, and introducing the course earlier in PSP careers. Overall, these findings support the use of ICBT as a proactive intervention for PSP with subthreshold symptoms and offer recommendations for refining ICBT delivery generally for high-stress occupations.